Sublingual immunotherapy (SLIT) which uses extracts of house dust mites, showed some benefit in reducing symptoms of Atopic Dermatitis in patients who are sensitive to mites. However, the primary outcome was not significantly improved, as new research shows.
The results of a tiny double-blind, randomized study that was placebo-controlled was published recently in The Journal of Allergy and Clinical Immunology: In Practice.
Lead author Sarah Sella Langer, MD of the Department of Medicine, Ribeirao Preto Medical School, University of Sao Paolo, Ribeirao Preto, in Brazil, and colleagues say their findings suggest that HDM SLIT is safe and effective as an addition treatment.
The therapy using extracts of dust mites did not cause any major adverse effects after 18 months of treatment, as the authors report.
Researchers used data from 66 patients who participated in the study. The participants were at least 3 years old and were registered at least 15 on the SCORing Atopic Dermatitis (SCORAD) measure, and had an examination of the skin or immunoglobulin E (IgE) test for sensitization to dust mites.
Patients were divided by age (younger than 12 years or 12 years and over) to receive HDM SLIT (n = 35) or placebo (n = 31) 3 days a week for the study period — between May 2018 and June 2020 at the Clinical Research Unit of Ribeirao Preto Medical School Hospital.
At baseline the mean SCORAD was 46.9 (range, 17-87).
After 18 months, 74.2% and 58% of patients in HDM SLIT and placebo groups respectively, had at least a 15-point reduction in SCORAD (relative risk [RR1.28; 95% CI, 0.89 – 1.28 95% CCI, 0.89 – 1.83). These primary outcomes didn’t have statistical significance.
On the other hand, some secondary outcomes showed significant results.
The researchers report significant objective SCORAD drops of 56.8% in HDM SLIT, and 34.9 percent, respectively, at 95% 95% CI (average difference, 21.3). Significantly more patients scored 0 or 1 . Investigator’s Global Assessment scale (5/31 vs 14/35; RR, 2.63).
There was no significant change in Eczema Area Index and Severity Index.
Participants in the study who had moderate to severe diseases were treated with the standard individualized therapy for AD in accordance with current guidelines and expert guidelines.
Tina Sindher, MD is an allergist at the Sean N. Parker Center for Allergy & Asthma research at Stanford University in Stanford, California. She said in Medscape Medical News that the results aren’t strong enough to recommend the immunotherapy widely.
She also noted that more than half the patients in the placebo group met the primary endpoint.
However, she did say that HDM SLIT can be used as an alternative treatment for patients at risk of having an allergic reaction or other adverse conditions. The most frequent adverse effects were headache and abdominal pain and they were reported in both the treatment and placebo groups.
With AD, she said “there is no one drug that’s right for everyone,” because genetics and environmental factors determine the type of symptoms, duration and severity differ for each patient.
It all boils down the risk and the benefits, she said.
Sindher said that she was considering sublingual dust mite therapy if she had a patient suffering from an allergy to environmental substances.
She said that without these conditions, dust mite immunotherapy wouldn’t outweigh the risks and potential burdens on patients who have to take the SLIT.
She stated that she would recommend the possibility to the patient and when other treatments have failed and the patient is interested in taking it on she would be open to a trial period.
The study was supported by the Brazilian National Council for Scientific and Technological Development and the Institute of Investigation in Immunology and the National Institutes of Science and Technology and the Brazilian National Council for Scientific and Technological Development and the Sao Paulo Research Foundation. The laboratory IPI-ASAC Brasil/ASAC Pharma Brasil was the source of the mite extract for immunotherapy. Langer was awarded a doctoral fellowship by the Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior – Brasil. Sindher has not disclosed any relevant financial relationships.
J Allergy Clin Immunol Pract. Published online on November 9 2021. Full text
Marcia Frellick is a freelance journalist based in Chicago. Follow her on Twitter @mfrellick.
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